July Newsletter

Itch Study

Pruritus is the sensation of an itch and can be either localized or generalized. It is triggered by an irritation to a specific type of nerve that leads to an itch sensation and the desire to scratch the skin. Itching can result from skin conditions, such as eczema, medication reactions

[1] or systemic illness[2]. It is defined as chronic when the symptoms of itching have been present for six weeks or longer, according to the International Society for the Study of Pruritus. The incidence of a chronic itch has been found to increase with age[3].


People who have itching often times seek medical care from their dermatologist, as it can contribute to a decrease in quality of life, including difficulty functioning and sleeping [4]. The Baker Allergy, Asthma and Dermatology Research Center is currently involved in a study researching an investigational treatment for chronic itching. If you or someone you know has chronic itching, are 18 years or older and would like additional information about the research study, please contact either Emily Widen, research coordinator or Erin Flamiatos, FNP in our research center at (503) 534-2622


1. Reich A, Stander S, Szepietowski JC. Drug-induced pruritus: a review. Acta dermatovenereologica. 2009;89(3):236-244.

2. Grundmann S, Stander S. Chronic pruritus: clinic and treatment. Annals of dermatology. Feb 2011;23(1):1-11.

3. Thaipisuttikul Y. Pruritic skin diseases in the elderly.  The Journal of dermatology. Mar 1998;25(3):153-157.

4. Dalgerd F, Stevensson A, Holm JO, Sundby J. Self-reported skin morbidity in Oslo. Associations with socioeconomic factors among adults in a cross-sectional study. The British journal of dermatology. Aug 2004;151(2):452-457.

Controlling Medication Costs

There is a reliable cost comparison website available online to assist with keeping medication costs down. It is called www.Goodrx.com and easily and efficiently compares costs of prescription medications between pharmacies in your local area. It has been evaluated by Consumer Reports and is recommended as the most effective and reliable website.

When medication deductibles are high or patients are paying out of pocket for medication, it is beneficial to shop around and compare prices. Pharmacies all have different prescription prices and are not required to have the same prices on prescription medications as their competitors do. Even pharmacies that are located close to each other may have widely varying prices, so it is wise to compare.

Visit: www.Goodrx.com

Nasacort AQ -  Now Available Over-the-counter!

Nasacort AQ (triamcinolone nasal) has been approved by the FDA to be sold over-the-counter at pharmacies in the United States now. The approval was given in February this year. Nasacort is an intranasal steroid spray that is approved for treatment of allergic rhinitis. It decreases nasal tissue swelling; therefore relieves congestion, along with nasal discharge and sneezing. It provides the most effective relief when used consistently through pollen season or year round for patients with indoor and outdoor allergies. 

When using a nasal spray, it is improtant to aim the spray toward the outside wall of the nose and avoid spraying toward the middle of the nose (nasal septum). 

The over-the-counter price for Nasacort ranges from $15-$20 depending on the pharmacy. It is available at Costo in a bulk package of 3 bottles for $34.49.

http://www.fda.gov/drugs/newsevents/ucm370973.htm

Testing for Food Allergies

We often times see pediatric patients for possible food allergies, who have already had ImmunoCAP blood testing performed for several foods that have varying degrees of positive IgE levels. These food allergy blood tests may come in panel forms that include testing to many foods the child consumes without any adverse reactions. The clinical challenge with having multiple foods tested with the blood test or skin prick test is that the false positive rates are up to 50% for food allergy testing [1]. Often times these false positive results can lead to significant amounts of confusion for the provider, the patient and the patient's parents. In addition, the results are challenging to interpret and a slightly elevated food IgE level may not be relevant with regard to true food allergy, but we see this reported commonly, even though a patient may tolerate the food and enjoy it. Although a patient may have IgE to a food protein present, it doesn't always mean that they cannot tolerate this food or should avoid it. The clinical picture must be taken into consideration.

In a 2010 study of 79 children who had smaller skin test results or mildly elevated blood tests to peanut protein, only 22.4% of the children reacted clinically to an oral challenge to peanut [2]. This helps confirm that sensitization doesn't always mean patients have a true food allergy.

In clinic we don't practice using blanket or panel allergy testing for this reason and we recommend skin prick testing over ImmunoCAP testing if possible. We prefer to test only the foods that a patient has reacted to and possibly additional foods that cross react with the allergenic food group. Overall, the patient's story of his or her personal reaction to the food trumps the food allergy testing results and the skin prick test trumps the ImmunoCAP blood test.

1. American College of Allergy, Asthma, & Immunology. Food allergy: a practice parameter. Ann Allergy Asthma Immunol 2006; 96:S1.

2. Maloney JM, Rudengren M, Ahlstedt S, et al. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol 2008; 122:145.

Asthma Research Center Studies - Accepting Patients

Asthma Research Center Studies 

Asthma is a chronic inflammatory airway disease characterized by airway inflammation, hyperresponsiveness and remodeling. Together, these features can cause wheezing, breathlessness, chest tightness and coughing. While typically more prevalent during the morning and night and in younger individuals, asthma exists with a variety of triggers and impairs the daily lives of over 25 million individuals in the United States [1].

The physiology of asthma involves the activity of multiple types of cells, including white blood cells, mast cells and macrophages. Long term treatment of the disease is commonly achieved by controlling the populations of these cell types through maintenance inhalers or antibody injections. Overall, the goal of treatment is to reduce the prevalence of asthma attacks and to diminish the need for rescue medication.

The Baker Research Center is currently accepting patients into studies for asthma control.
Those 12 and older who have suffered from asthma may be eligible to enroll in an asthma study and receive free standardized treatment.

To Qualify:

• Patient must be 12 years of age or older.
• Patients must be on a stable dose of asthma medication without the use of prednisone in the past month.
• Patients must also meet criteria for uncontrolled asthma and show lung function improvement when given albuterol.

For more information on these studies or to see if you qualify, contact Julie Anderson or Michelle Walsh at 503-534-2622.

[1] Akinbami LJ, Moorman JE, Bailey C, Zahran HS, King M, Johnson CA, et al. Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief. 2012 May;(94):1-8





Pollen Season Has Arrived

If you suffer from allergic rhinitis you may have already noticed the arrival of the pollen this spring. The pollen count for Oregon is based out of Eugene and is published on The American Academy of Allergy, Asthma and Immunology website:

https://www.aaaai.org/global/nab-pollen-counts.aspx

The most recent count on 4/3/14 showed tree pollen ranking high and grass low. Tree pollen was first posted in early February and grass has been posted intermittently at low counts since late March.

Allergies may be treated by avoiding the allergen trigger, taking medication to treatment symptoms and/or treatment with immunotherapy [1]. We offer immunotherapy in the forms of allergy injections (subcutaneous immunotherapy) and allergy drops (sublingual immunotherapy). Sublingual immunotherapy (SLIT) is administered in the form of drops under the tongue on a daily basis.

Over-the-counter antihistamines are commonly used to treat allergic rhinitis and may relieve a runny nose and itchy eyes. However, if you are experiencing nasal congestion, you may need to add in an intranasal steroid spray in order to decrease the congestion. If you take Zyrtec daily, we recommend using Allertec, which is found at Costco for $15.99 for an entire year supply.

If you need an updated allergy care plan or testing to determine the type of treatment best for you, please schedule an appointment at 503 636-9011.

[1] Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol 1998; 81:478.